Provider Demographics
NPI:1700466208
Name:PADMORE, MICHAEL ANSUMANA (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANSUMANA
Last Name:PADMORE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 FALLGOLD PKWY N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2087
Mailing Address - Country:US
Mailing Address - Phone:763-218-4147
Mailing Address - Fax:
Practice Address - Street 1:3903 FALLGOLD PKWY N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55443-2087
Practice Address - Country:US
Practice Address - Phone:763-218-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-2463934163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse